CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

812

Heart Failure Among People With HIV: Prescription of Guideline Directed Medical Therapy Melissa K. Cutshaw 1 , Robert M. Clare 2 , Karen Chiswell 2 , Paul Hofmann 2 , April C. Pettit 3 , Chris Longenecker 4 , Matthew S. Durstenfeld 5 , Gerald Bloomfield 2 , Nwora L. Okeke 1 1 Duke University School of Medicine, Durham, NC, USA, 2 Duke Clinical Research Institute, Durham, NC, USA, 3 Vanderbilt University Medical Center, Nashville, TN, USA, 4 University of Washington, Seattle, WA, USA, 5 University of California San Francisco, San Francisco, CA, USA Background: People with HIV (PWH) have an increased risk of heart failure (HF), and HF outcomes among PWH are worse than in persons without HIV. Guideline-directed medical therapy (GDMT) is the cornerstone of HF management but is often suboptimally prescribed. Despite poor HF outcomes in PWH, little is known about GDMT prescription among PWH with HF. Methods: We conducted retrospective analyses of the PATHWAYS study, a multi-institutional observational study of underrepresented racial and ethnic groups in the Southern U.S. from 2014-2020. Adult patients with a systolic HF ICD-9 or ICD-10 code on or after the first date of HIV diagnosis were included. A composite 3+ pillar GDMT score was constructed using dosage-weighted prescription of GDMT drugs (beta-blockers [BB], renin-angiotensin system [RAS] inhibitors, mineralocorticoid receptor antagonists [MRA], and hydralazine [for Black patients only]), with a maximum score of 100% indicating optimal GDMT ( Table 1 ). Covariates of interest included age, sex, social deprivation index [SDI], rural address, insurance type, HIV characteristics, ambulatory clinic visits, and select comorbidities. Among patients with systolic HF, associations between covariates and the maximum GDMT score within one year of HF diagnosis were estimated using unadjusted means ratios. Results: Among 451 PWH with systolic HF, the median age was 54 years (interquartile range [IQR] 47-62), 34.6% were female, 96.6% were Black, and 3.6% were Hispanic. The median CD4 count was 332 (IQR 173-618). Prescription of any GDMT occurred in 85.8% of patients. Overall, 74.5% of patients were prescribed BB, 58.8% were prescribed RAS inhibitors, 22.2% were prescribed MRA, and 21.4% of eligible patients were prescribed hydralazine. The mean GDMT score was 30% (standard deviation [SD] 22%). Lower average GDMT scores occurred in patients with higher SDI scores (0.97, 95% CI: 0.94-0.99) and severe renal disease (0.84, 95% CI: 0.72, 0.99). Higher average GDMT scores occurred in patients with diabetes mellitus (unadjusted mean ratio 1.25, 95% confidence interval [CI] 1.09-1.44), hypertension (1.39, 95% CI: 1.14-1.69), elevated LDL cholesterol (1.34, 95% CI; 1.06-1.69), obesity (1.16, 95% CI: 1.00 1.35), and prior myocardial infarction (1.18, 95% CI: 1.02-1.36). Conclusions: People with HIV and HF had low GDMT scores, indicating suboptimal intensity of HF care. Further studies are needed to investigate potential disparities in GDMT prescription among people with and without HIV.

813

Mitochondrial Haplogroups and Left Ventricular Dysfunction in People Living With and Without HIV Craig Cronin 1 , Jing Sun 2 , Jorge R. Kizer 3 , Katherine C. Wu 1 , David Samuels 4 , Frank Palella 5 , Shehnaz Hussain 6 , Jeremy Martinson 7 , Nicole Armstrong 8 , Claudia Martinez 9 , Caitlin A. Moran 10 , Yasmeen Golzar 11 , Federico M. Asch 12 , Jason Lazar 13 , Todd Brown 14 1 The Johns Hopkins Hospital, Baltimore, MD, USA, 2 The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 3 University of California San Francisco, San Francisco, CA, USA, 4 Vanderbilt University Medical Center, Nashville, TN, USA, 5 Northwestern University, Chicago, IL, USA, 6 University of California Davis Medical Center, Davis, CA, USA, 7 University of Pittsburgh, Pittsburgh, PA, USA, 8 University of Alabama at Birmingham, Birmingham, AL, USA, 9 University of Miami Miller, Miami, FL, USA, 10 Emory University Hospital, Atlanta, GA, USA, 11 Cook County Health and Hospitals System, Chicago, IL, USA, 12 MedStar Health Research Institute, Hyattsville, MD, USA, 13 SUNY Downstate Medical Center, Brooklyn, NY, USA, 14 The Johns Hopkins University School of Medicine, Baltimore, MD, USA Background: Mitochondrial dysfunction is implicated in the development of heart failure, which is more common in people with HIV (PWH) than those without HIV (PWoH). Whether genetic variations in mitochondrial DNA (mtDNA) are related to cardiac dysfunction, specifically left ventricular diastolic dysfunction (LVDD), has not been well studied in PWH. Methods: We included men from the Multicenter AIDS Cohort Study (MACS) and women from the Women’s Interagency HIV Study (WIHS) who participated in standardized echocardiographic studies. LVDD was defined using the Characterizing Heart Function on Antiretroviral Therapy (CHART) study criteria, which excludes individuals with reduced LV ejection fraction. mtDNA haplogroups were inferred from genotyping data using HaploGrep. We used multivariable logistic regression to examine the sex- and race-stratified association between LVDD and common African haplogroups (L0L1, L2, L3, or “other”) for males and females or European haplogroups (H, UK, JT, or “other”) for males. We further evaluated for interactions between HIV serostatus and haplogroups. The model controlled for principal components of nuclear genetic ancestry, age, BMI, educational level, alcohol intake, hepatitis C status, and clinical characteristics relevant for LVDD (hypertension, diabetes mellitus, dyslipidemia, and eGFR). Results: Among 842 men (455 PWH and 387 PWoH), 574 self-identified as White and 268 as Black with a median age of 59 [IQR: 46, 72] and prevalence of LVDD of 24.2% (24.2% PWH and 24.3% PWoH). All 591 women (397 PWH and 194 PWoH) self-identified as Black with a median age of 52 [IQR: 40, 64] and prevalence of LVDD of 26.9% (27.0% PWH and 26.8% PWoH). For men with HIV, the odds of LVDD were 48% lower in European haplogroup H than for men in non-H haplogroups (OR, 0.52; 95% CI, 0.28-0.97; Figure ). There were no significant associations between haplogroups of African origin and LVDD in men. For women with HIV, the odds of LVDD were 57% lower in African haplogroup L2 (OR, 0.43; 95% CI, 0.22-0.81; Figure ). HIV status significantly modified the association of haplogroup L2 and LVDD in women ( P interaction =0.025). For PWoH, there were no significant associations between haplogroups and LVDD. Conclusions: Common mitochondrial haplogroups (i.e. H, L2) are significantly associated with lower odds of LVDD among PWH, but not among PWoH. Mitochondrial genetic variations may protect against cardiac diastolic dysfunction in the setting of HIV infection, particularly among Black women.

Poster Abstracts

CROI 2025 244